This proposal tests the predictive value of measurements of large and small vessel compliance & pulse wave velocity (PWV), with non-invasive techniques, in evaluating cardiovascular and renal disease. The proposed studies will test two groups undergoing concurrent research protocols. The first group is a cohort of young African-Americans at high risk of hypertension based on a family history of hypertension. This group will be comprehensively profiled by echocardiography, proteinuria quantification, and determination of endothelial function. Vascular compliance and PWV will be obtained and compared with these profiles to determine the additional value of compliance measurements compared with routine blood pressure measures pursuing the hypothesis that these simple non-invasive methods provide effective screening for end organ effects (cardiac, renal and endothelial). This will provide cross sectional information on an at-risk cohort. The second group includes 500 patients with CKD to be enrolled in the NIH sponsored, multi-center Chronic Renal Insufficiency Cohort Study, in which our center (Penn) is a research site. This will provide cross sectional and longitudinal data from a prospective cohort pursuing the hypothesis that vascular compliance measurements have prognostic value in predicting specific cardiovascular and renal outcomes. Evaluating both groups will enhance greatly the predictive spectrum of these compliance assessments and provide the candidate with broad exposure to hemodynamic physiology and access to a wealth of longitudinally-obtained data in an important national prospective cohort study.